|Dr. W. Christopher Urban|
Glen Burnie, MD
As intervertebral discs age, they often undergo degenerative changes that cause “bulging.” In most cases, bulging discs are considered normal because they do not cause symptoms. Many people are unaware that they have bulging discs. In some situations, such as spinal stenosis or degenerative disc disease, a bulging disc may produce back or leg pain. It is essential to correlate a patient’s medical history, physical examination, and imaging studies (MRI) to determine whether or not a “bulging disc” is normal. A herniated disc, in contrast, is one in which the outer layer of the disc, called the annulus, is incompetent and abnormal. Because of this weak surrounding architecture, it is possible for the inner disc material to squeeze out of the disc. Depending on the size and location of the herniated fragment, a patient may or may not become symptomatic. If the herniated disc material were to press against a nerve root, for example, it could cause leg pain or numbness.
|Dr. Jeffrey Goldstein|
New York, NY
Nobody really knows. We don't know the answer to that question. There's a normal process of loss of water within the disc material, which is cartilage. It has a very high water content. In all people the disc loses some water during a process of dehydration. For some people that can cause a problem and in other people it does not. The process of dehydration itself is a normal one. Whether it leads to significant compromise of the function of the disc or why it happens in some people and not others is unclear.
|Dr. Allan Levi|
While bulging or herniated discs are not normal, they are common and are associated with the spectrum of degenerative disc disease.
|Dr. Rick Sasso|
Yes, they can be normal in that they are commonly seen in people and in MRI scans that are obtained in people that have no pain. And the vast majority of degenerated discs that have bulges in them - in fact, the vast majority of herniated discs where actually a piece of the disc is sitting in the spinal canal, most of those people that have those on their MRI scans don't have any pain.
|Dr. Mark Testaiuti|
Yes, certainly bulging discs are part of the normal aging / degenerative process that begins to occur as early as the teens or early twenties. Herniated discs are usually not "normal" but also may not be the cause of a person's neck pain.
|Dr. Moe R. Lim|
Chapel Hill, NC
Just as it is “normal” for our skin to wrinkle with age, the spine can develop bulges and herniations caused by the wear-and-tear effects of aging. However, if the bulges or herniations compress the nerve roots and/or spinal cord, it can cause symptoms and is abnormal.
|Dr. Dennis G. Crandall|
Most people over age 40 have some disk bulging on their MRI scan, even if they do not have any pain. Disk herniations can also occur without causing symptoms. These are usually smaller herniations without significant nerve or cord compression.
|Dr. Mark R. McLaughlin|
Bulging discs are not normal and represent the early stages of disc and joint degeneration or arthritis. Although the bulge may not compress nerves or the spinal cord, it is an early sign of an abnormal joint.
|Dr. Kambiz Hannani|
Los Angeles, CA
Bulging and herniated discs are very common in the general population. This means that a bulging disc is usually normal and rarely causes any significant problems. If bulging discs are operated on without first performing the proper diagnostic tests, the results are usually unsatisfactory because neck pain is rarely caused by simple bulging discs.
|Dr. B. Theo Mellion|
Bulging discs are not uncommon. A bulging disc that impinges on the nerve roots or the spinal canal can cause problems but it does not always. Therefore, bulging discs do not always require an operation and they can be fairly commonly but they can also be the cause of pain, numbness or weakness. It really depends on the size of the bulge and where it is located.
|Dr. David S. Baskin|
All discs bulge to a certain extent, as they serve as a kind of shock absorber for the spine. Therefore, a bulging disc is often a normal finding. At times, the outer fibers of the disc can be massively stretched, so that the outer containing ring is no longer as tight as it should be. In this case, the disc can bulge more than it should, and cause problems by putting pressure on nerve structures.
A herniated disc, as I defined above, is not normal. However, many people have small herniated discs that are not clinically significant, because they do not produce nerve pressure, and therefore do not produce symptoms.
|Dr. Daniel Resnick|
Bulging discs are extremely common. The incidence of significant disc changes on an MRI scan is almost identical to the age of the patient. For example, if 100 40-year old patients underwent MRIs of the cervical spine, approximately 40% of them would show some degenerative disc changes. While these changes are technically abnormal, they are extremely common and occur as a consequence of the normal aging process.
|Dr. Douglas Slaughter|
Herniated discs are not normal. They are pathologic conditions that can necessitate surgery. Bulging discs are normal aging phenomena or natural phenomena of a desiccated or degenerative disc.
|Dr. Randy Davis|
Glen Burnie, MD
The process of degeneration and loss of water in the shock absorbers, which is the function the disc serves, is a normal process of aging. Many patients can have bulging discs without evidence of pain and there are evidence of herniations on MRIs in patients who are not having significant problems. It is not entirely clear why some patients have pain with bulging or herniated discs and others do not.
|Dr. Kevin Yoo|
Bulging or herniated discs are not normal if you think that a normal neck is a completely healthy neck without any changes caused by aging. Bulging discs and even herniated discs are fairly common. So they can be seen in the necks of patients without any symptoms. A herniated disc only requires medical or even surgical treatment if it causes symptoms.
|Dr. Timothy C. Ryken|
Iowa City, IA
Nearly every MRI, even in patients with no pain, will have "bulging" or "herniated" discs reported. If these do not relate specifically to a patient's symptoms, they are most likely just incidental findings.
|Dr. Sean Salehi|
30% of people with no neck pain have evidence of disc degeneration such as bulging or small disc herniation. This is part of the normal wear and tear of the disc tissue. Smoking or activities that put increased pressure on the disc can accelerate such a degeneration.
|Dr. Paul Saiz|
A bulging disc can be a normal finding in the spine. Herniated disc is not a normal finding and infers that a piece of “jelly” has squirted out of the doughnut and is in an area where it should not be making contact with nerves.
|Dr. Brian Subach|
Most people have some degree of spinal degeneration manifest as either bone spurs or disc bulges. It is very common but usually only identified when the disc causes problems.
|Dr. Joseph Alexander|
The process of degeneration, which affects the discs in the cervical spinal area, is a currently unavoidable consequence of aging. If one looks at the spines of patients in their 60's and 70's, virtually all of them will have at least some signs of degenerated or herniating discs. If one looks at MRI's of people without any symptoms in their 30's and 40's, as many as one-third of these people will have a herniated disc which is not causing them any current symptoms. So, in this sense, herniated or bulging discs do occur as a normal consequence of aging. They become abnormal if they are causing severe symptoms that interfere with a person's life.
|Dr. Robert S. Pashman|
Los Angeles, CA
No, they are not "normal" in that we are not born with herniated or bulging discs. They are very common and occur with age and natural dehydration and degeneration of the disc. MRI studies of asymptomatic patients showed that approximately 40% of the population has herniated or bulging discs.
|Dr. Theodore A. Belanger|
A bulging disc is something that can commonly be found in people who have no pain, and is considered a normal finding in the aging spine. A herniated disc, while it is not considered normal, may or may not cause symptoms. If it is not causing symptoms, then it does not require any treatment. If a herniated disc is causing symptoms, then treatment is necessary, either conservatively or with surgery depending on the specific circumstances.
|Dr. Jeffrey C. Wang|
Los Angeles, CA
Certainly it is normal to get arthritis in the discs with age and it is not uncommon to see small disc bulges which do not appear to be causing significant nerve compression. However the more serious protrusions can cause significant symptoms.
|Dr. Sebastian Lattuga|
Rockville Centre, NY
Both disc bulges and disc herniations can be found in people without pain. There is an increasing incidence of herniations and bulges in people as they get older (presumably from increased wear and tear). Technically, bulges and herniations are not the normal state of the spine.
|Dr. John Peloza|
No, they are not normal. The normal shape or morphology of the disc is that it should be a uniform height with an abundant fluid content without any bulging of the disc wall into the spinal canal. A bulging disc reflects degeneration, which is a physiologic (normal) process of aging, but the disc itself is not normal. It is showing signs of wear-and-tear. A herniated disc obviously is not normal. It is essentially a torn or broken disc. However, the fact that a disc is bulging or herniated does not necessarily mean that it is symptomatic or painful.
The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.
It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.